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Genant HK generic differin 15gr on line skin care jogja, Heck LL 15gr differin overnight delivery skin care for winter, Lanzl LH et al (1973) Primary hyper- parathyroidism: A comprehensive study of clinical, biochemi- short in height. There is often premature loss of dentition cal, and radiographic manifestations. Radiology 109:513-524 due to resorption of dentine, with replacement of the pulp 20. Am J Roentgenol 104:884-892 The radiographic features closely resemble those of 21. Genant HK, Baron JM, Strauss FH et al (1975) Osteosclerosis in primary hyperparathyroidism. Am J Med 59:104-113 Paget’s disease, but are diagnostic as they involve the 22. Skelet Radiol, whole skeleton and affect children from the age of 2 18:415-426 years. Wishart J, Horowitz M, Need A, Nordin BE (1990) 40 years, and skeletal involvement is either monostotic or Relationship between forearm and vertebral mineral density in asymmetrically polyostotic. On radionuclide scanning, postmenopausal women with primary hyperparathyroidism. Arch Intern Med 150:1329-1331 there is a generalized increase in uptake, giving a “super 24. Silverberg SJ, Gartenberg F, Jacobs TP et al (1995) Increased scan”, due to excessive osteoblastic activity, with absence bone density after parathyroidectomy in primary hyper- of evidence of renal uptake. Semin Dial 15(4)277- roidism: analysis of 52 cases, including report of new case. Gipstein RM, Coburn JW, Adams JA et al (1976) 28) Salvesen HA, Boe J (1953) Idiopathic hypoparathyroidism. Calciphylaxis in man: A syndrome of tissue necrosis and vas- Acta Endocinol 14:214-226 cular calcification in 11 patients with chronic renal failure. Ryan EA, Reiss E (1984) Oncogenous osteomalacia: Review Pseudohypoparathyroidism - An example of “Seabright- of the world literature of 42 cases. Curr Ther Endocrinol Metab 5:492-495 pseudohypoparathyroidism (PH) and pseudo-pseudohy- 56. Steendijk R, Hauspie RC (1992) The pattern of growth and poparathyroidism (PPH). Differentiation from other syn- growth retardation of patients with hypophosphataemic vita- dromes associated with short metacarpals, metatarsals and min D-resistant rickets: longitudinal study. Glorieux FH, Marie PJ, Pettifor JM, Delvin EE (1980) Bone of shortening of the bones of the hands in PHP and PPHP – a response to phosphate salts, ergocalciferol and calcitriol in hy- comparison with brachydactyly E, Turner’s syndrome, and pophosphatemic vitamin D-resistant rickets. Milgram JW Compere CL (1981) Hypophosphatemic vitamin pseudohypoparathyroidism Semin Musculoskel Radiol D refractory osteomalacia with bilateral pseudofractures. O’Malley SP, Adams JE, Davies M, Ramsden RT (1988) The with secondary hyperparathyroidism and osteitis fibrosa. Polisson RP, Martinez S, Khoury M et al (1985) Calcification Feldman D, Glorieux FH, Pike JW (eds). Chapter 60, Vitamin of entheses associated with X-linked hypophosphatemic os- D, Elsevier Academic Press, San Diego, California, pp 967-994 teomalacia. Adams JE, Davies M (1986) Intra-spinal new bone formation Clin North Am 19:582-598 and spinal cord compression in familial hypophosphataemic 37. Glorieux FH, St-Arnaud R (1997) Vitamin D vitamin D resistant osteomalacia. Hardy DC, Murphy WA, Siegal BA et al (1989) X-linked hy- Vitamin D, Academic Press, San Diego, California, pp 755- pophosphatemia in adults: prevalence of skeletal radiographic 764 and scintigraphic features. Econs MJ, Samsa GP, Monger M et al (1994) X-linked hy- dent rickets Type II, resistance of target organs to 1,25-dihy- pophosphatemic rickets: a disease often unknown to affected droxyvitamin D. McCance RA (1947) Osteomalacia with Looser’s nodes Radiol Clin North Am 29:97-118 (Milkman’s syndrome) due to raised resistance to vitamin D 40. Brill PW, Winchester P, Kleinman PK (1998) Differential di- acquired about the age of 15 years. In: Bone growth in health and dis- duced osteomalacia: a surgically curable syndrome, report of ease. Taybi H, Lachman R (1996) Radiology of syndromes, meta- (1961) Hypophosphatasia: a genetic study. Looser E (1920) Uber spatrachitis und osteomalacie Klinishe pophosphatasia: report of severe and mild cases.

Answer B: The internal acoustic meatus contains the vestibulo- tributes to the facial muscles around the eye 15 gr differin with amex skin care 90036. None of the other cochlear nerve cheap differin 15 gr otc acne 6 days before period, the facial nerve, and the labyrinthine artery, a choices contains fibers related to the corneal reflex. A vestibular schwannoma located in the meatus would likely affect the facial 13. Answer B: The callosomarginal artery, a branch of the anterior nerve and result in facial weakness. The vagus and glossopharyn- cerebral artery, serves the medial aspect of the superior frontal geal nerves exit the skull via the jugular foramen (along with the gyrus and that portion of this gyrus on the superior and lateral as- accessory nerve). The cerebellar arteries originate within the skull pects of the hemisphere. M4 segments of the middle cerebral and distribute to structures within the skull. Answer C: The lingual gyrus is the lower bank of the calcarine sul- sphere caudal to the parietoccipital sulcus, and the angular artery cus; the upper (cuneus) and lower banks of this sulcus are the loca- (an M4 branch) serves the angular gyrus of the inferior parietal lob- tion of the primary visual cortex. The lenticulostriate arteries are branches of M1 that serve in- of the parietal lobe, and the angular gyrus is a portion of the inferior ternal structures of the hemisphere. The cingu- late and parahippocampal gyri are located on the medial aspect of the 14. Answer B: The limbic lobe, consisting primarily of the cingu- hemisphere and are parts of the limbic lobe. None of the other The internal cerebral vein (to the great cerebral vein) drains the lobes of the cerebral cortex borders directly on the corpus callo- internal parts of the hemisphere; the ophthalmic vein connects the sum. Answer B: The inferior frontal gyrus consists of the pars or- with the transverse sinus. Answer A: As they descend in the dural sac from their origin 45 in the dominant hemisphere will result in a nonfluent (Broca) from the spinal cord to their exit at their respective intervertebral aphasia. The supramarginal (area 40) and angular (area 39) gyri foramen, the anterior and posterior roots form the cauda equina. The lateral one-third of the precen- the filum terminale internum is the strand of pia that extends from tral gyrus is the face area of the somatomotor cortex. Answer A: Areas 3, 1, 2 collectively represent the primary so- ally to the inner surface of the dural sac, and the filum terminale matosensory cortex. Area 4 is the primary somatomotor cortex, externum anchors the dural sac caudally to the inner aspect of the area 17 the primary visual cortex, and area 22 the primary audi- coccyx. Area 40 is in the supramarginal gyrus, a large part of which is called the Wernicke area. Answer B: The primary somatomotor cortex consists of the precentral gyrus and the anterior paracentral gyrus; area 4 is found 17. Answer D: The body is represented in the somatomotor cortex in these structures. Areas 3, 1, and 2 are the primary somatosen- (precentral gyrus, anterior paracentral gyrus) in the following pat- sory cortex; areas 5 and 7 make up the superior parietal lobule and tern: the face in about the lateral one-third of the precentral gyrus the precuneus; and area 6 is located rostral to area 4. Portions of above the lateral sulcus; the hand and upper extremity in about its area 6 in the caudal region of the middle frontal gyrus are the middle third; and the trunk and hip in about its medial third. Answer A: In this patient, the meningioma is located in the falx cation of the frontal eye field. Answer C: The L4-L5 interspace is commonly used for a lum- in the anterior paracentral gyrus (somatomotor) and in the poste- bar puncture. Because the caudal end of the spinal cord (the tains the motor representation for the face (lateral part) and the conus medullaris) may be as low as L2 in some individuals, levels trunk and hip (medial part). The postcentral gyrus is part of the T12-L1 to L2-L3 are not used, as this would most likely result in somatosensory cortex. The S1-S2 vertebrae are fused so there is no intervertebral space through which a needle can pass. Answer D: The M4 segments of the middle cerebral artery serve thermore, the dural sac ends at about S2. Answer B: The oculomotor nerve (III) exits from the medial as- sels that serve the pre- and postcentral gyri (hemorrhage into ap- pect of the midbrain into the interpeduncular fossa/cistern. It tra- proximately the lower two-thirds of these gyri explain the motor verses this space, courses through the lateral wall of the cavernous and sensory deficits) are the precentral branches (prerolandic), sinus to eventually enter (along with the trochlear [IV] and ab- central branches (Rolandic branches), and anterior parietal ducens [VI] nerves) the superior orbital fissure. The M2 segment serves the insular cortex, and the M3 VI, and V (the ophthalmic portion of the trigeminal nerve), along segment serves the inner surface of the frontal, parietal, and tem- 1 poral opercula.

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Sounds of high frequency (red arrow) cause pressure waves to displace the basilar membrane near its base generic 15 gr differin amex skin care advice. For example trusted 15 gr differin acne x out reviews, striking the high C on a piano produces a high frequency of sound that has a high pitch. Pathways for Hearing The intensity, or loudness of a sound, is directly related to the amplitude of the sound waves. Sound intensity is measured Sound Waves in units known as decibels (dB). A sound that is barely audible— Sound waves travel in all directions from their source, like rip- at the threshold of hearing—has an intensity of zero decibels. These waves of energy are Every 10 decibels indicates a tenfold increase in sound intensity: characterized by their frequency and their intensity. The fre- a sound is 10 times higher than threshold at 10 dB, 100 times quency, or number of waves that pass a given point in a given higher at 20 dB, a million times higher at 60 dB, and 10 billion time, is measured in hertz (Hz). The healthy human ear can detect very related to its frequency—the higher the frequency of a sound, small differences in sound intensity—from 0. Sensory Organs © The McGraw−Hill Anatomy, Sixth Edition Coordination Companies, 2001 Chapter 15 Sensory Organs 523 Thalamus Auditory cortex (temporal lobe) Inferior colliculus Medial geniculate Midbrain body of thalamus Cochlear nucleus Medulla oblongata Vestibulocochlear nerve From spiral organ (of Corti) FIGURE 15. A snore can be as loud as 70 dB, as compared with 105 dB Sounds of low pitch (with frequencies below about 50 Hz) for a power mower. Frequent or prolonged exposure to sounds cause movements of the entire length of the basilar membrane— with intensities over 90 dB (including amplified rock music) can result in hearing loss. Higher sound frequencies result in maximum displacement of the basilar membrane closer to its Sound waves funneled through the external acoustic canal base, as illustrated in figure 15. Displacement of the basilar membrane and hair cells by Movements of the tympanum during ordinary speech (with an movements of perilymph causes the hair cell microvilli that are average intensity of 60 dB) are estimated to be equal to the di- embedded in the tectorial membrane to bend. As the vestibular window is displaced, pressure waves pass Neural Pathways for Hearing through the fluid medium of the scala vestibuli (fig. Movements of Cochlear sensory neurons in the vestibulocochlear nerve (VIII) perilymph within the scala tympani, in turn, displace the synapse with neurons in the medulla oblongata, which project to cochlear window into the tympanic cavity. Neurons in this When the sound frequency (pitch) is sufficiently low, there area in turn project to the thalamus, which sends axons to the is adequate time for the pressure waves of perilymph within the auditory cortex of the temporal lobe, where the auditory sensa- scala vestibuli to travel around the helicotrema to the scala tym- tions (nerve impulses) are perceived as sound. As the sound frequency increases, however, these pressure waves do not have time to travel all the way to the apex of the cochlea. Instead, they are transmitted through the vestibular Mechanics of Equilibrium membrane, which separates the scala vestibuli from the cochlear Maintaining equilibrium is a complex process that depends on duct, and through the basilar membrane, which separates the continuous input from sensory neurons in the vestibular organs cochlear duct from the scala tympani, to the perilymph of the of both inner ears. The distance that these pressure waves travel, pal source of sensory information for equilibrium, the photore- therefore, decreases as the sound frequency increases. Sensory Organs © The McGraw−Hill Anatomy, Sixth Edition Coordination Companies, 2001 524 Unit 5 Integration and Coordination proprioceptors of tendons, muscles, and joints also provide sen- Eyes Joint, tendon, sory input that is needed to maintain equilibrium (fig. Vestibular apparatus muscle, and The vestibular organs provide the CNS with two kinds of cutaneous receptors receptor information. One kind is provided by receptors within the saccule and utricle, which are sensitive to gravity and to lin- ear acceleration and deceleration of the head, as occur when rid- Cerebellum Vestibular nuclei (brain stem) ing in a car. The other is provided by receptors within the semicircular ducts, which are sensitive to rotational movements, as occur when turning the head, spinning, or tumbling. When the hair cells are displaced in the direc- (control of eye movements) movements) tion of the kinocilium, the cell membrane is depressed and becomes depolarized. When the hair cells are displaced in the opposite direction, the membrane becomes hyperpolarized. Kinocilium Stereocilia Cell membrane (b) At rest (a) (c) Stimulated (d) Inhibited FIGURE 15. Sensory Organs © The McGraw−Hill Anatomy, Sixth Edition Coordination Companies, 2001 Chapter 15 Sensory Organs 525 Vestibular nerve Macula of the utricle Cochlea (a) Macula Macula of Gelatinous the saccula material Statoconia Stereocilia Gelatinous material Hair cells Hairs of hair cells bend Gravitational force Sensory Supporting nerve fibers cells Creek (b) (c) FIGURE 15. Saccule and Utricle (otolithic) membrane, that supports microscopic crystals of cal- cium carbonate called statoconia (otoliths). The statoconia in- Receptor hair cells of the saccule and utricle are located in a crease the weight of the statoconial membrane, which results in small, thickened area of the walls of these organs called the mac- a higher inertia (resistance to change in movement). Cytoplasmic extensions of the hair When a person is upright,the hairs of the utricle project cells project into a gelatinous mass, called the statoconial vertically into the statoconial membrane,whereas those of the saccule project horizontally. During forward acceleration,the sta- toconial membrane lags behind the hair cells,so the hair cells of macula: L. Sensory Organs © The McGraw−Hill Anatomy, Sixth Edition Coordination Companies, 2001 526 Unit 5 Integration and Coordination Vestibular nerve Ampullae Cochlea (a) Cupula Hair bundle Crista ampullaris Hair cells Supporting cells Sensory nerve fibers Creek (b) (c) FIGURE 15.

The interior of the eyeball is separated by the lens and its associ- The large posterior cavity is filled with a transparent jelly- ated lens capsule into an anterior cavity and a posterior cavity like vitreous humor effective differin 15gr acne 5 days past ovulation. The anterior cavity is subdivided by the iris into ular pressure that maintains the shape of the eyeball and holds an anterior chamber and a posterior chamber (see fig order differin 15gr free shipping skin care quiz. Unlike aqueous humor, vitreous The anterior chamber is located between the cornea and the iris. Additional vitreous humor forms as a person’s eyes become pensory ligament and lens. Aqueous humor also Puncture wounds to the eyeball are especially dangerous and provides nutrients and oxygen to the avascular lens and cornea. Protective equipment such as goggles, shields, and shatterproof lenses should be used in haz- An estimated 5. If the eye is punctured, the the vascular epithelium of the ciliary body (fig. From its main thing to remember is to leave the object in place if it is still im- site of secretion within the posterior chamber, the aqueous paling the eyeball. Removal may allow the fluids to drain from the humor passes through the pupil into the anterior chamber. From eyeball, causing loss of intraocular pressure, a detached retina, and possibly blindness. Sensory Organs © The McGraw−Hill Anatomy, Sixth Edition Coordination Companies, 2001 Chapter 15 Sensory Organs 509 Postganglionic sympathetic axon IN DIM LIGHT From superior cervical ganglion Pupillary dilator muscle (radially arranged smooth muscle fibers of the iris) Pupillary constrictor muscle (circularly arranged smooth muscle fibers of the iris) IN NORMAL LIGHT Pupil Postganglionic parasympathetic axon Ciliary ganglion From oculomotor IN BRIGHT LIGHT nerve FIGURE 15. In dim light, the radially arranged smooth muscle fibers are stimulated to contract by sympathetic stimulation, dilating the pupil. In bright light, the circularly arranged smooth muscle fibers are stimulated to contract by parasympa- thetic stimulation, constricting the pupil. Function of the Eyeball Transmission of Light Rays The focusing of light rays and stimulation of photoreceptors of Light rays entering the eyeball pass through four transparent media the retina require five basic processes: before they stimulate the photoreceptors. In sequence, the media through which light rays pass are the cornea, aqueous humor, lens, 1. The cornea and lens are solid media composed eyeball; of tightly packed, avascular protein fibers. Refraction occurs as light Visual impairment may result if one or more of these rays pass at an oblique angle from a medium of one optical den- processes does not function properly (see Clinical Considerations). Sensory Organs © The McGraw−Hill Anatomy, Sixth Edition Coordination Companies, 2001 510 Unit 5 Integration and Coordination (a) Fibers of the optic nerve Ganglion neurons FIGURE 15. Bipolar neurons Photoreceptor neurons cortex of the occipital lobe, where the inverted image is inter- preted as right side up. Pigmented layer Choroid layer Accommodation of the Lens Accommodation is the automatic adjustment of the curvature of Sclera the lens by contraction of ciliary muscles to bring light rays into sharp focus on the retina. Contraction of the smooth muscle that light must pass through various layers of nerve cells before fibers of the ciliary body causes the suspensory ligament to relax reaching the photoreceptors (rod cells and cone cells). The lens is particularly important for refining and altering refraction. Of the refractive Constriction of the pupil occurs through parasympathetic stimula- media, only the lens can be altered in shape to achieve precise tion that causes the pupillary constrictor muscles of the iris to con- refraction. Pupillary constriction is important for two The refraction of light rays is so extensive that the visual reasons. One is that it reduces the amount of light that enters the image is formed upside down on the retina (fig. A reflexive constriction of the pupil protects the impulses of the image in this position are relayed to the visual retina from sudden or intense bright light. Sensory Organs © The McGraw−Hill Anatomy, Sixth Edition Coordination Companies, 2001 Chapter 15 Sensory Organs 511 Macula lutea Fovea centralis Optic disc Choroidal vessels (a) (b) FIGURE 15. Optic nerve fibers leave the eyeball at the optic disc to form the optic nerve. Hold the drawing about 20 inches from your face with your left eye closed and your right eye focused on the circle. Slowly move the drawing closer to your face, and at a certain point the cross will disappear. This occurs because the image of the cross is focused on the optic disc, where photorecep- tors are absent.

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